Is the HPV Vaccine Racist?

Woman With Her Daughters
Yellow Dog Productions/Stone/Getty Images

There was an uproar after Duke University released a study showing that the existing HPV vaccines might not effectively protect African American women from cervical cancer, genital warts, and other HPV related conditions. Some people began to question whether the vaccine development process was racist. (Please note: much of the science in the previous link is inaccurate). I started to get questions about it myself.

Unfortunately, the answer to whether the HPV vaccine is racist isn't a simple yes or no. To an extent, it depends on how you define racism. Are you wondering if the scientists developing the vaccines set out to protect White women at the expense of Black women? That answer is almost certainly no. However, there is pervasive institutional racism  in the academic and research communities. That definitely contributed to the situation we are in today.

First, it helps to understand what the Duke researchers found. In their study, they looked a multiethnic cohort of women with varying degrees of cervical abnormalities. What they found was that the types of HPV that caused the majority of pre-cancerous and cancerous lesions in women of African ancestry were different than the ones most likely to cause those lesions in women of European ancestry. There was an overlap. However, the prevailing types differed in the two groups.

Existing vaccines are targeted against the two types that most commonly cause cancers in women of European descent. Therefore, they are likely to be at least somewhat less effective in women of African descent.

The racism inherent in the vaccine's development comes from the fact that this disparity is news.

Most research studies on oncogenic HPV subtypes had been performed on Whilte men and women. It was widely believed that the same oncogenic subtypes were reasonably well conserved across populations. A quick search on Pubmed, the major medical literature search engine, shows how this happened. Out of more than 2300 papers on HPV genotypes, only seventeen were looking in African Americans. That number goes up to 57 if you expand the search to all African populations. However, it still reflects a major problem in the way medical research is done today. With certain notable exceptions, non-Whites are vastly underrepresented in study populations. As such, the scientists developing the current vaccines had every reason to believe they were properly addressing the most common cancer and wart causing variants of the virus. There was no plausible way they could have known they were just addressing the types that were most common in women of European descent.

In other words, if you want to call the HPV vaccine racist, you're not wrong.

However, you also need to call the development of most other drugs, tests, and medical interventions racist. It's well known that a number of medical products work differently in people of differing ethnicities, because of variations in genetic and behavioral factors. There are probably many more products where such disparities exist but  haven't yet been found. The racism isn't unique to HPV research. It's pervasive, and no one has yet found an effective way to deal with it.

It's clear that scientists have to work harder to recruit minority participants in their studies. However, that isn't easy. There have been too many breaches of trust, such as with the Tuskegee Incident. These have had a lasting impact on the way in which minorities, particularly African Americans, interact with the medical establishment. The legacy has proven difficult to repair.

As for the racism seen in the likely differential effectiveness of the HPV vaccine across populations, improved cervical screening may be the best way to deal with it. A lot of the studies that have shown that 16 and 18 are the most common subtypes have been done on tissue samples banked after cervical biopsies. As preventative care coverage improves under the Affordable Care Act, there is some hope that more diverse populations will be able to afford screening. Then, presumably, more diverse samples will become part of the database used for future studies and vaccine development.


Chalela P, Suarez L, Muñoz E, Gallion KJ, Pollock BH, Weitman SD, Karnad A, Ramirez AG. Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives. J Community Med Health Educ. 2014 Apr 24;4(281):1000281.  

Charleswell CA. Commentary: clinician and researcher contributions to disparities in racial and ethnic minority participation in human subjects research. Ethn Dis. 2014 Summer;24(3):298-301.

Chen MS Jr, Lara PN, Dang JH, Paterniti DA, Kelly K. Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT): laying the groundwork for improving minority clinical trial accrual: renewing the case for enhancing minority participation in cancer clinical trials. Cancer. 2014 Apr 1;120 Suppl 7:1091-6.    

Vidal AC, Smith JS, Valea F, Bentley R, Gradison M, Yarnall KS, Ford A, Overcash F, Grant K, Murphy SK, Hoyo C. HPV genotypes and cervical intraepithelial neoplasia in a multiethnic cohort in the southeastern USA. Cancer Causes Control. 2014 Aug;25(8):1055-62.

Continue Reading